Provider Demographics
NPI:1548889942
Name:HARRINGTON, AMANDA JO
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E GRAND PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:IL
Mailing Address - Zip Code:62451-1254
Mailing Address - Country:US
Mailing Address - Phone:618-586-2153
Mailing Address - Fax:
Practice Address - Street 1:209 E GRAND PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:IL
Practice Address - Zip Code:62451-1254
Practice Address - Country:US
Practice Address - Phone:618-586-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily